Intensive care units-acquired urinary tract infections: a 5-year multicenter retrospective study in Istanbul

Urinary tract infection (UTI) is the most common hospital-acquired infection worldwide. Nosocomial UTI develops due to swelling of the urinary catheter. This study was conducted to determine the pathogens associated with catheter-associated urinary tract infection (CAUTI), identify these microorganisms, and investigate antimicrobial resistance patterns in intensive care units-acquired CAUTIs of two hospitals during 5 years.

Semiquantitative culture of urine samples was done in both hospitals. Identification and sensitivity of microorganisms were made using conventional methods and automated systems. Susceptibility testing was performed according to Clinical and Laboratory Standards Institute (CLSI) standards and European Committee on Antimicrobial Susceptibility Testing (EUCAST). All 24,882 patients were admitted to the intensive care units (ICUs) at both hospitals.

A total of 677 microorganisms were isolated from 580 patients. The CAUTI rate observed in patients was 580/24,882 (2.33%). The most common microorganisms isolated were E. coli (184; 27.18%), K. pneumoniae (128; 18.9%), and enterococci (104; 15.36%). Vancomycin resistance was noted in 10.6% of all enterococci. Staphylococci were not resistant to vancomycin. The most effective antibiotics for Gram-negative bacteria were colistin (90.5%), followed by amikacin (77.4%), meropenem (66.6%), and imipenem (66.4%). High rates of extended-spectrum beta lactamase (ESBL) was noted in 54.3% and 69.5% of E. coli and K. pneumoniae, respectively.

Universal recommendations on the use of catheters should be carefully applied to prevent the development of the infection. Patients who are infected by multidrug resistant (MDR) microorganisms should be followed carefully. Both centers should develop their own policies on this issue.